Dermatitis: Causes, Types, Symptoms, and Treatment Guide

What Is Dermatitis?

Dermatitis is a general term that refers to the inflammation (swelling and irritation) of the skin. It is also known as eczema, which is a set of inflammatory conditions that affect the skin, making it itchy, red, dry, scaly, and irritated. Dermatitis is not contagious (it does not spread from person to person), but it can be chronic (long-term), recurrent (repeated), and very uncomfortable.

What Are the Causes of Dermatitis (Eczema)?

The actual cause of eczema is quite complicated. A combination of the following causes it:

• Overactive immune system (body’s defense system reacting too strongly).
• Genetic factors (run in families).
• Impaired skin barrier (skin cannot properly protect itself).
• Environmental factors.

The risk factors are as follows:

• Weakened immune system.
• Health conditions like hay fever and asthma.
• Dry skin or health conditions like psoriasis.
• Insect bites.
• Vein disorders, such as weak veins.
• Environmental factors.
• Change in genes.
• Stress.
• Wet hands and feet.
• Allergies to chemicals, metals, or certain substances.
• Irritants from hairdressing, laundry, or dry cleaning.

Current research has also shown that eczema is strongly linked to defects in skin barrier proteins, specifically filaggrin gene mutations (a gene defect that affects the skin barrier), and to the immune system's mechanisms involving IL-4 and IL-13 (inflammatory proteins). Biologic therapies (targeted immune drugs) are now being developed based on these inflammatory mechanisms.

What Are the Symptoms of Dermatitis?

Symptoms may include:

• Dry, cracked, and scaly skin.
• Redness.
• Itching, which may be severe.
• Painful lesions.
• Change in color at sites of skin rashes.
• Thickened skin with rashes.
• Fluid-filled blisters.
• Crusting or oozing.
• Skin discoloration (lighter or darker patches).
• Itching and scratching can lead to skin infections.

Who Develops Dermatitis?

Anyone can develop dermatitis, regardless of age. Diaper rash and cradle cap might affect the baby. Eczema, or atopic dermatitis, typically first appears in children, but it can affect people of any age. Since contact dermatitis only involves skin-to-substance contact, anyone can get it. Dermatitis herpetiformis (a specific itchy rash) is more common in people who have celiac disease.

What Are the Phases of Eczema?

The phases of eczema are:

• Acute Phase:

There will be erythema (redness) in the acute phase; edema or swelling; vesiculation or fluid-filled lesions; discharge; and crusting.

• Subacute Phase:

The subacute phase is characterized by hyperpigmentation, scaling, and crusting.

• Chronic Phase:

In the chronic phase, lichenification will occur. It is a combination of thickening, hyperpigmentation, and prominent skin markings.

How Can Eczema Be Classified?

It can be divided into two groups. They are

A. Exogenous Eczemas (External Causes):

Exogenous eczemas could be either irritant or allergic in nature. The types of exogenous eczemas are:

1. Irritant Contact Dermatitis:

It is a type of eczema caused by many agents whose toxins or excretory products cause variable degrees of involvement depending on their concentration and the duration of contact with the skin of everyone exposed to them.

These agents can be any of the following:

• Chemical: Detergents, soaps, acids, etc.
• Physical: Sunlight, heat, etc.
• Biological: Bacteria, viruses, mites, lice, etc.

2. Allergic Contact Dermatitis:

• Unlike irritant contact dermatitis, allergic contact dermatitis occurs only in those who become allergic to the causative external allergens. A great majority of those exposed continue to remain unaffected regardless of the duration of exposure.
• Allergic contact eczemas may occur due to footwear, cosmetics, hair dyes, pollens, etc.

3. Airborne Contact Dermatitis (ABCD):

• Pollen and other airborne allergens mainly affect the face, eyes, 'V' of the neck, and other uncovered areas of the body.

B. Endogenous Eczemas (Internal Causes):

Some common types of endogenous eczemas are as follows.

1. Atopic Dermatitis:

Atopic dermatitis is chronic eczema. It is one of the atopic (natural tendency to develop allergies) conditions, together with asthma and hay fever, that have a heritable tendency.

2. Seborrheic Dermatitis:

There is excessive sebum (oil) secretion in this type of eczema, presenting with scaly, itchy lesions on the scalp, nasolabial folds, the sternal areas, and body folds.

3. Discoid Eczema:

Discoid eczema is a chronic, recurrent, discrete, coin-shaped, red area covered with exudates that crusts on the limbs and trunk of middle-aged individuals, due to unknown causative factors. Sometimes, distinguishing discoid eczema from psoriasis can be challenging.

4. Pompholyx:

In this type of eczema, vesicular (fluid-filled) eruptions are generally seen on the palms or soles. The lesions may be non-inflammatory, chronic, and recurrent. The exact cause of pompholyx is not known.

How Is Dermatitis Diagnosed?

The diagnosis of allergic contact dermatitis can be established by doing a patch test.

In this test,

• Patches of suspected allergens in appropriate concentrations are put on the non-hairy skin of the back or arms.
• Readings are taken after 48 to 72 hours.

The positive patch test reaction is indicated by:

• Redness.
• Fluid-filled eruptions (vesicles).
• Ulceration at the test site.

What Are the General Principles of Therapy?

• To achieve rapid resolution and prevent relapses, it is helpful to explain to the patient the causes of disease initiation and perpetuation, and to advise corrective measures.
• Discontinuation of contact with the offending agent leads to rapid resolution.
• In general, the management of eczema depends on its extent and chronic nature.
• Oral antihistamines such as Cetirizine or Levocetirizine can reduce itching.

How Can Eczema Be Treated Locally?

Treatment of eczema includes:

• Treatment for Acute Stage:

Normal saline or potassium permanganate (1:10,000 dilution) compresses or soaks are used to wash away serous discharges, crust, and debris, and to help reduce oozing and inflammation. Calamine lotion should not be used. In case of discharge, avoid ointments or creams. Corticosteroids can be given in lotion form.

• Treatment for Subacute Stage:

When there is no oozing or discharge, or in cases of subacute or dry eczema, corticosteroid cream can be applied locally twice daily. A local antibiotic cream, with or without a corticosteroid, is helpful when bacteria are present.

• Treatment for Chronic Stage:

When the skin becomes thick or lichenified, an occlusive dressing with a corticosteroid ointment is required. Alternatively, a moderately potent corticosteroid ointment can be applied locally two to three times a day. The addition of three percent salicylic acid to the corticosteroid ointment is beneficial.

How Can Eczema Be Treated Systemically?

It is required in widespread acute or subacute cases and selected chronic cases.

• Intralesional steroids 0.1 to 0.2 ml (10 mg/ml) per sq. cm should be given.
• Oral antihistamines should be given in a suitable dose, depending on the individual tolerance, the nature of the job, and the patient's age.
• Appropriate antibiotics are helpful in case of secondary infection.
• Newer options, such as biologics and JAK inhibitors, are available for moderate-to-severe eczema.
• Systemic corticosteroids like oral Prednisolone, with other supportive measures, are tried in severe cases with extensive involvement only and not as a routine. The dose and duration depend on the merits of the cases.

What Is the Diet Recommended for Eczema?

Foods that may help include omega-3-rich foods (such as fatty fish), quercetin-rich foods (such as broccoli, cherries, and blueberries), and an anti-inflammatory diet. Foods to avoid (if allergic) include soy, dairy, and processed foods. Eliminating foods from your diet regularly is not advised unless an allergy test has been confirmed.

What Are the Lifestyle and Home Cures?

The lifestyle changes include:

• Use an ointment or cream to relieve itching.
• Moisturize twice a day.
• Use fragrance-free products.
• Apply a cool, damp cloth (15 to 30 minutes).
• Oatmeal baths.
• Medicated dandruff shampoos (coal tar, Zinc pyrithione, and Ketoconazole).
• Bleach bath (as advised by the doctor).
• Wear gloves at night.

How to Prevent Eczema?

The preventive measures are:

• Avoid substances that trigger or worsen the symptoms.
• Take the medication as prescribed.
• Apply ointments and creams as advised by the doctor.
• Apply moisturizer frequently.
• Avoid sudden changes in temperature or humidity.
• Use fragrance-free detergents, cleansers, and skincare products.
• Wear protective gloves and clothing while handling chemicals.
• Reduce stress.

What Are the Complications of Eczema?

Open wounds and cracks can result from persistent scratching that tears the skin. These raise the possibility of bacterial and fungal infections. Although uncommon, these skin infections can develop and become fatal.

Dermatitis may result in the affected skin becoming lighter or darker in individuals with brown or black skin. Post-inflammatory hypopigmentation and post-inflammatory hyperpigmentation are the terms used for these conditions. The skin may take months or even years to return to its natural hue.

When to Visit a Doctor?

If you notice symptoms such as a rash that develops very quickly, severe pain or fever, or infection symptoms like pus and swelling, visit a doctor.

Conclusion

Eczema, or dermatitis, is a common inflammatory skin condition characterized by itching, redness, dryness, and a rash. Although it cannot be cured in all cases, it can be managed effectively with proper care. In recent years, there has been a marked improvement in patient outcomes due to early diagnosis and the availability of modern treatment modalities, such as biologic agents for severe eczema. If you have persistent skin irritation, you can consult a skin care specialist for further guidance.

Key Takeaways

• Dermatitis (eczema) results in itchy, red, dry, and inflamed skin.
• It occurs due to allergens, irritants, genetic factors, and immune system disorders.
• The doctor decides the treatment plan based on the type of your dermatitis.
• Moisturizers, topical steroids, antihistamines, and biologic agents are used for managing severe dermatitis.
• Prompt treatment can prevent worsening of the infection and skin thickening.